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Based on policy and procedure review, medical record review, and staff interviews, the hospital failed to comply with 42 CFR §489.20 and §489.24.

The findings include:

Based on policy and procedure review, medical record review, and staff interviews, the hospital failed to ensure a complete medical screening examination was provided within the capability of the hospital's Dedicated Emergency Department (DED) including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed for 1 of 7 sampled behavioral health patients presenting for a psychiatric evaluation (Patient #3)

~cross refer to 489.24 (a) & 489.24 (c), Medical Screening Exam - Tag A2406

Based on policy and procedure review, medical record review, and staff interviews, the hospital failed to ensure a complete medical screening examination was provided within the capability of the hospital's Dedicated Emergency Department (DED) including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed for 1 of 7 sampled behavioral health patients presenting for a psychiatric evaluation (Patient #3).


The findings include:

Review of facility policy "EMTALA Policy, VH-RM 37" last revised 09/2021 revealed "...Emergency Department Patient Medical Screening...Qualified Medical Personnel...Non-physician providers including nurse practitioner, certified nurse midwife and physician assistants can perform a medical screening exam under their privileges and recommended by the Medical Staff...Qualified Medical Personnel Procedures 1. A Qualified Medical Person shall provide a Medical Screening Examination to all patients who come to the emergency department..."

Closed medical record of Patient #3 revealed a 15-year-old male who presented to Hospital A's DED on 11/2/2021 at 2138 with an arrival complaint of " Psych " . Review revealed he was placed in a room at 2159 and triage began at 2201 along with the MSE (Medical Screening Exam) by Physician Assistant (PA) #1. Review revealed at 2203 " Chief Complaints Updated: Psych Exam (Dad stated that he put a cat in the microwave last week and attacked a neighbor today with a knife. Dad said that he hasn't missed any of his medications but change in behavior started last week. Dad called it " having spells " pt. (patient) is alert and oriented to self, place and time.) " . Orders placed for Geodon (antipsychotic medication) 10 milligram (mg) at 2213. Review revealed inpatient case manager consult placed at 2214 and disposition set for discharge at 2215. Review revealed Geodon given at 2223 and Patient #3 departed at 2244.

Review of " ED Provider Notes " on 11/02/2021 at 2216 revealed "(History of Present Illness) HPI... is a 15yrs, Male w PMH (past medical history) of autism presents emergency department for evaluation with his father. The child was previously living in a group home in (named city) for 2 years. Patient left the group home Monday of last week, after " a safety event " . Patient unfortunately placed a worker ' s cat in a microwave, resulting in death of a cat. As a result of this, he was discharged from the group home. His father has been attempting to get into an inpatient hospital in (named city) (where he was previously admitted). This evening, a neighbor came over to the home to visit his grandmother. Patient #3 grabbed a butter knife and displayed violent behavior, however, never actually stabbed anyone. The patient was able to be subdued and the butter knife easily removed from his hand. His father brought him here this evening for evaluation based on the above event. His father has previously removed all other sharp knives such as steak knives and any weapons out of the home ...ED COURSE/PLAN: Had a long discussion with father at bedside. The child has behavioral disorder that is difficult to manage with both medication and cognitive therapy. His father would like medication here this evening to sedate him and facilitate him going to sleep. His father feels comfortable with the child being discharged and taking the patient back home. There is already a case manager working on facilitating getting him institutionalized back at (named facility) I have also placed a case management order in the EHR (Electronic Health Record), a father expressed interest in the child going to (named hospital) ... "

Interview on 12/08/2021 at 1225 with PA#1 revealed he recalled Patient #3. Interview revealed the father felt safe taking the patient home. Interview revealed Patient ' s father has been looking for long term placement for Patient #3 after he was discharged from the group home. Interview revealed he placed a case management consult to assist in placement of Patient #3. Interview revealed Patient did not need psychiatric consult and the patient was stable for discharge.

Interview on 12/08/2021 1040 with CM (Case Manager) #1 revealed consults ordered after hours are printed and reviewed. Interview revealed once a psychiatric patient has been discharged, they do not follow up on consults ordered.

Patient #3 did not receive an appropriate medical screening exam for his presenting complaint.